health assessment

Head and Neck Examination

• An examination of the head and neck includes assessment of various structures.
• Structures include the head, eyes, ears, nose, mouth, pharynx, and neck.
• Neck includes lymph nodes, carotid arteries, thyroid gland, and trachea.
• Assessment methods involve inspection, palpation, and auscultation.

Head Assessment

• Begins with inspecting the client's head position and facial features.
• A normal head is held upright and still.
• Assess facial feature shape and symmetry via eyelids, eyebrows, nasolabial folds, and mouth.
• Assess size, shape, and contour of the skull.
• Palpate the skull to check for nodules or masses.

Neck Assessment

• Assessed through inspection and palpation.
• Inspect the neck for symmetry, masses, and scars.
• Look for enlargement of the parotid or submandibular glands and any visible lymph nodes.
• Trachea and thyroid size and position, ROM, lymph nodes, and venous distention need to be noted.
• Palpate lymph nodes with the pads of the index and middle fingers, moving skin over underlying tissue.
• Patient should be relaxed and the neck needs to be slightly flexed forward.
• Examination can be performed on both sides simultaneously.
• Risk factors include past injuries, infections, and history of thyroid problems.
• Assess ROM by asking the patient to tilt their head backward, forward, and side-to-side.
• No neck vein distention should be visible.

Eyes and Ears

• Sensory organs that transmit visual and auditory stimuli to the brain for interpretation.
• Turning fork and Snellen chart are used.

Eye Assessment

• Assesses external structures, pupils, iris, visual acuity, extra ocular movements, peripheral vision, and internal eye structures.
• Factors to consider include age, corrective lenses, artificial eye, allergies, pain, and visual disturbances.

External Eye Structure

• Assess alignment of the eyelids, eyelashes, lacrimal glands, pupils, and iris
• Check eyebrows for distribution or scaliness.
• Check lacrimal gland and lacrimal sac.

Pupils

• Inspect for size, shape, and symmetry.
• Inspect the cornea and lens for opacity that may be visible through the pupil.
• Normal pupils are black, equal in size, round, and smooth.
• Assess PERRLA (Pupils Equal, Round, Reactive to Light and Accommodation)

Visual Acuity and EOM (Extra Ocular Movements)

• Use a Snellen's Chart
• EOM assesses 8 Cardinal Fields.

Ear Assessment

• Inspect for lumps, deformities, and skin lesions.
• Ask about pain, discharge, and inflammation.
• Move the auricle, press the tragus, and press firmly behind the ear.

Hearing Assessment

• Assessed one ear at a time.
• Assess hearing via whisper test
• Stand 1-2 feet away to administer whisper test

Four Types of Hearing Loss or Deafness

• Conductive hearing loss is caused by diseases or obstruction in the outer or middle ear and is usually not severe.
• A person with a conductive hearing loss generally can be helped by a hearing aid and can also be corrected through surgical or medical treatment.
• Sensorineural hearing loss results from damage to the sensory hair cells or the nerves of the inner ear, ranging from mild to profound deafness.
• Loss occurs in certain sound frequencies, resulting in distorted sound perceptions even when the sound level is amplified. A hearing aid may not help.
• Mixed hearing loss is caused by problems in both the outer or middle ear and the inner ear.
• Central hearing loss results from damage to or impairment of the nerves or nuclei of the central nervous system.

Weber's Test

• Assesses bone conduction
• Activate a tuning fork and place its base on the center of the patient's head.
• Ask the patient where the sound is heard best.
• Conductive hearing loss causes the patient to hear the sound better in the affected ear because bone transmits the sound directly.
• Normal findings include the sound being heard equally in both ears or in the middle.

Rinne's Test

• Compares air conduction (AC) to bone conduction (BC).
• Activate tuning fork.
• Hold the base of the tuning fork against the mastoid process and ask the client when the sound can no longer be heard.
• Immediately place the still vibrating tuning fork close to the external ear canal and ask if the patient can hear the sound.
• Normal findings: AC is better than BC (+ Rinne with AC > BC)
• If the hearing loss is Conductive, BC will be = or > AC

External Ear Examination

• Inspect for shape, size, and lesions.
• Shape and size should be symmetrical and proportionate to the head.
• Palpate gently for pain, edema, or presence of lesions.
• Abnormal findings include unequal height and size, uneven color, and lesions.
• Use an otoscope.
• Insert the speculum with the client's head slightly tilted away.

Ear Canal Examination

• In adults, the ear canal is straightened by gently pulling the pinna up and back.
• In children under 3, the ear canal is straightened by pulling the pinna down and back.
• Check for wax, discharge, and foreign bodies.
• Normal findings: The ear canal should be smooth and pinkish.
• The tympanic membrane should be intact without redness or discharge; translucent, shiny, and gray.
• Abnormal findings: pain when manipulating the pinna, redness of the canal, nodules on the auricle.

Nose Examination

• Test for patency by occluding one nostril at a time, asking the patient to inhale.
• Mucous membrane is examined for color and the presence of exudates or growths.
• Nasal mucosa should be moist and redder than oral mucosa.

Sinus Examination

• Frontal and maxillary sinuses are examined for pain and edema.
• Palpate the frontal sinuses by gently pressing upward on the bony prominences above each eye.
• Palpate the maxillary sinuses by gently pressing the bony prominences of the upper check.
• Palpate for sinus tenderness and do transillumination
• Evaluate olfactory nerve for client's ability to identify common smells on each nares separately.

Mouth and Pharynx

• Structures: Lips, tongue, gums, hard & soft palate, salivary gland, tonsillar pillars, & tonsils
• Materials needed: penlight, tongue blade or depressor, gloves
• Assess by inspection and palpation.
• Palpate the temporomandibular joint
• Normal findings: The lips should be pink, moist, and smooth. The tongue and mucous membrane are pinkish, moist, and free of swelling and lesions.
• Abnormal findings: Swelling and redness of the mucous membranes and lesions of the mucosa and lips

Oral Mucosa

• Inspect the oral mucosa for color, ulcers, white patches, and nodules, using a light and tongue blade.

Gums and Teeth

• Note the color of the gums (normally pink) and inspect the teeth (should be 32 teeth).
• Note missing, broken, or diseased teeth.
• Normal tooth color varies from white, yellow, or gray.

Tongue

• Inspect the sides and undersurface of the tongue and the floor of the mouth because these areas are where cancer most often develop.
• Note any white or reddened areas, nodules, or ulcerations.

Pharynx Assessment

• With the patient's mouth open but the tongue not protruded, ask the patient to say "ah" and inspect the soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx.
• The uvula should remain in the midline position.
• Note the color and symmetry of the uvula, and look for exudates, swelling, and ulceration or tonsillar enlargement.

Trachea and Thyroid Gland Assessment

• Palpate for alignment and position.
• To orient yourself to the neck, identify the thyroid and cricoid cartilages, and the trachea below them.
• Inspect the trachea for any deviation from its usual position.
• Inspect the neck for the thyroid gland.
• Palpate the thyroid gland from behind.
• It is in the midline of the suprasternal notch.
• Unequal space between the trachea and the sternocleidomastoid muscle on each side indicates tracheal displacement.